Lung cancer screening recommendation could affect DoD, VA care

Aug. 16, 2013 - 04:46PM
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An influential independent panel is recommending that heavy smokers over age 55 — a group that includes many military retirees and veterans — should be screened annually for lung cancer.

The U.S. Preventive Services Task Force issued a draft recommendation in late July proposing that those at high risk for lung cancer receive a low-dose CT scan each year to detect possible tumors.

The group defined “high risk” as those between the ages of 55 and 80 who have smoked an average of one pack a day for 30 years.

It also includes anyone who has quit in the past 15 years but also meets the 30-year, pack-a-day threshold.

Until now, the scientific community has been divided on whether lung cancer screening leads to effective treatment. But panel members found enough evidence to show that the benefits of a scan, which include exposure to small doses of radiation, outweigh the risks.

“By screening those at high risk, we can find lung cancer at earlier stages when it is more likely to be treatable,” said task force chairwoman Dr. Virginia Moyer.

The proposal could have a significant impact on the Veterans Affairs and Defense departments, which treat a population with historically high smoking rates.

The prevalence of smoking among veterans is estimated to be up to 40 percent higher than among the general population.

And a 2011 Defense Department survey of active-duty troops showed nearly a quarter smoked, with Marines having the highest rate, nearly 32 percent, and Air Force the lowest, at 17 percent.

Military personnel also may be at higher risk for the disease, which kills 90 percent of those who develop it, because of environmental contaminants encountered during military operations, from chemical fumes and carbon monoxide to air pollution from waste disposal plants and open-air burn pits.

“For our military men and women and veterans who are at even higher risk of lung cancer because of exposures during their service to our country, screening is a life-saving gift that now will not longer be denied. It is the responsibility of DoD and the VA to make certain that those at high risk are aware of the stakes and this service is provided to them without delay,” Lung Cancer Alliance president Laurie Fenton Ambrose said.

Tom Murphy, a former Marine and Vietnam veteran, was diagnosed in 2010 with lung cancer after he enrolled in a low-dose CT scan screening study at Johns Hopkins University.

A heavy smoker who quit in 2000 after 40 years, he volunteered for the research after taking into account probable Agent Orange exposure and family history. His father died of lung cancer.

“I got my first scan in 2005 and there was nothing unusual. I continued yearly until 2008 and skipped 2009. I went back in 2010, and there was something there,” Murphy said.

He was advised that doctors could monitor the tumor’s growth, conduct a biopsy to determine whether it was cancerous or remove it. He opted for surgical excision.

“From my perspective, it had to come out,” he said.

Murphy, who now runs half-marathons and babysits his grandchild, believes he is alive today because of the yearly scans.

“I had no symptoms, no coughing, nothing,” he said.

The Walter Reed National Military Medical Center began offering low-dose CT scans for lung cancer screening in late 2012.

Smoking accounts for about 85 percent of lung cancer, according to the American Lung Association.

The screens also are offered at the VA Phoenix Health Care System and are scheduled to be offered at eight more sites in the next two months: Ann Arbor, Mich.; Charleston, S.C., Cincinnati; Durham, N.C., Minneapolis, NY Harbor, N.Y.; Portland, Ore., and San Francisco.

The pilot will last about two years, according to VA officials.l

As with any cancer screenings, CT scans can increase the risk of misdiagnosis. CT scans also expose patients to low doses of radiation.

Task Force co-vice chair Dr. Michael LeFevre said physicians will need to consider a patient’s history, overall health, age and number of years smoked to decide whether the person would benefit from annual screening.

He added, however, that quitting smoking is the most effective way to ward off cancer.

“People who quit smoking will continue to see their risk go down over time. Screening for lung cancer is beneficial, but it is not an alternative to quitting smoking,” LeFevre said.

The task force is soliticing public comment on its draft recommendations until Aug. 26. It will integrate comments and suggestions before publishing its final recommendations.